Intramedullary spinal cord glioma with intracranial seeding.

Hely, M. A.; Fryer, James P.; Selby, G

doi:10.1136/jnnp.48.4.302

Cited by 39 publications

(11 citation statements)

References 11 publications

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“…This high predisposition for leptomeningeal spread has also been observed by others. [1,6,7] However, its presence in six of 13 patients at diagnosis in our study, before surgical intervention, is unprecedented and may reflect the sensitivity of MR imaging for detecting this condition.…”

Section: Discussionmentioning

confidence: 71%

“…[1] These patients develop not only local recurrences but frequently widespread leptomeningeal metastases. [6,7,10] No uniform surgical, radiotherapeutic, or chemotherapeutic approach has been validated for such tumors. The Children's Cancer Group (CCG) 945 High-grade Astrocytoma Committee devised a pilot study to collect natural history information and explore the benefit of an experimental multimodality treatment in children with newly diagnosed high-grade astrocytomas arising within the spinal cord.…”

mentioning

confidence: 99%

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Treatment of high-grade spinal cord astrocytoma of childhood with “8-in-1” chemotherapy and radiotherapy: a pilot study of CCG-945

Allen¹,

Aviner²,

Yates³

et al. 1997

FOC

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The purpose of this study was to devise an improved method of treating high-grade gliomas of the spinal cord in children who have a dismal prognosis following conventional treatment. Eighteen children with newly diagnosed high-grade astrocytomas arising in the spinal cord were enrolled in the Children's Cancer Group (CCG) protocol 945. Following surgery, they were all assigned to receive two courses of “8-drugs-in-1-day” (8-in-1) chemotherapy prior to radiotherapy and eight additional courses thereafter. A centralized neuropathology review was used to confirm the diagnosis of high-grade astrocytoma in 13 of the 18 children: anaplastic astrocytoma, (eight patients), glioblastoma multiforme (four patients), and mixed malignant glioma (one patient). Diagnoses were discordant in five patients. There were eight boys and five girls in the group with confirmed diagnoses, with a median age of 7 years (range 1-15 years). The extent of resection was confirmed by computerized tomography or magnetic resonance (MR) evaluation in five of 13 patients. There were six gross-total or near-total resections (>90%), four partial or subtotal resections (10-90%), and three biopsies. Six patients showed evidence of leptomeningeal metastases at diagnosis based on staging MR examinations. Eight of the 13 patients completed at least eight of the prescribed 10 courses of chemotherapy; five received craniospinal radiotherapy and five spinal radiotherapy. The 5-year progression-free and total survival rates for the 13 children were 46 ± 14% and 54 ± 14%, respectively. Seven patients suffered a relapse at the primary site, four of whom also had leptomeningeal metastases. Seven of the 13 patients (54%) remain alive at the time of this report at a median of 76 months (range 51-93 months) from study entry. Six patients died between 8 and 38 months after diagnosis, all with active disease. Intensification of therapy may further improve outcome in this high-risk population.

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Section: Discussionmentioning

confidence: 71%

mentioning

confidence: 99%

Treatment of high-grade spinal cord astrocytoma of childhood with “8-in-1” chemotherapy and radiotherapy: a pilot study of CCG-945

Allen¹,

Aviner²,

Yates³

et al. 1997

FOC

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“…Linstadt et al [29] mentioned three patients (all age groups) with high-grade intraspinal astrocytoma, all of whom had a local relapse and two of whom also had dissemination. Altogether, reports on more than 30 patients with intracranial and intraspinal seeding after local therapy for highly malignant intraspinal astrocytoma have been published [10,18,20,23,29]. Of all recorded cases with high-grade intraspinal astrocytoma no patient was alive 5 years after diagnosis, whereas in patients with low-grade spinal astrocytomas the 5-year survival rate reaches 90% [25,29].…”

Section: Discussionmentioning

confidence: 95%

Intraspinal high-grade astrocytoma in a child - rationale for chemotherapy and more intensive radiotherapy?

Weiss

Klingebiel

Kortmann

et al. 1997

Child's Nervous System

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Intraspinal high-grade astrocytoma in children is an extremely rare tumor entity with disappointingly short survival times despite multimodality treatment. We report on a girl with anaplastic astrocytoma at level T9-11, who was treated with tumor resection, multidrug chemotherapy and irradiation. Local recurrence was diagnosed after 16 months. With reference to other cases reported in the literature, the course of disease, achievements and limitations of currently available therapeutic options, and potential future strategies are discussed.

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“…In the six cases reported of glial tumors arising in the irradiated field following treatment for Hodgkin's lymphoma, significant doses were received by the spinal cord, of between 37.8 and 49.69 Gy ( Table 1). The radiationinduced cerebral glioblastomas were more likely to occur in the physical penumbra at the margins of the treatment field than at the center, where the maximum dose had been received [3,20].…”

Section: Discussionmentioning

confidence: 99%

Glioblastoma of the Conus Medullaris Following Treatment of Hodgkin's Lymphoma: History of a Case and Literature Review

Pichon¹,

Champiat²,

Aumont³

et al. 2017

OMICS J Radiol

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Purpose: Reports of a glioblastoma arising in a previously irradiated field are rare in the literature, even more so in the conus medullaris of the spinal cord. Method:Case report and review of the literature reporting other radiation-induced intra-medullary glioblastomas. Results:We report a case of glioblastoma of the conus, which subsequently metastasized to the brain, arising in a 45 years old man, nine years after treatment for Hodgkin's lymphoma, which had included the administration of 41 Gy to the brain and spinal cord. Conclusion:Despite a well-conducted treatment by several lines of chemotherapy, the pronostic of radiationinduced glioblastoma is poor especially since these patients often cannot benefit from a re-irradiation due to the maximum dose supported by the spinal cord. Implications of cancer survivors:Associations are now established between therapeutic exposures and specific complications but considerable inter-individual variability is observed for a given therapeutic exposure. In this context, identification of genetic susceptibilities for specific treatment-associated late effect is a very promising future approach. Improvement in our knowledge on genetic susceptibilities may help define more personalized primary therapies that weigh treatment efficacy with the risk of late complications.

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Intramedullary spinal cord glioma with intracranial seeding.

Cited by 39 publications

References 11 publications

Treatment of high-grade spinal cord astrocytoma of childhood with “8-in-1” chemotherapy and radiotherapy: a pilot study of CCG-945

Treatment of high-grade spinal cord astrocytoma of childhood with “8-in-1” chemotherapy and radiotherapy: a pilot study of CCG-945

Intraspinal high-grade astrocytoma in a child - rationale for chemotherapy and more intensive radiotherapy?

Glioblastoma of the Conus Medullaris Following Treatment of Hodgkin's Lymphoma: History of a Case and Literature Review

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